Stanton wrote a chapter analyzing different views on alcohol, whether as good or evil, and how these views impact drinking practices. In the U.S., public health authorities and educators continuously broadcast negative information about alcohol, while young people and others continue to drink excessively and dangerously. An alternate model is to encompass beverage alcohol in an overall positive and healthy lifestyle, in which alcohol is assigned a limited but constructive role. Positive drinking cultures also hold people responsible for their drinking behavior and are intolerant of disruptive drinking.

Promoting Positive Drinking:

Alcohol, Necessary Evil or Positive Good?

Stanton Peele
Morristown, NJ

Historically and internationally, cultural visions of alcohol and its effects vary in terms of how positive or negative they are and the likely consequences that they attach to alcohol consumption. The dominant contemporary vision of alcohol in the United States is that alcohol (a) is primarily negative and has exclusively hazardous consequences, (b) leads frequently to uncontrollable behavior, and (c) is something that young people should be warned against. The consequences of this vision are that when children do drink (which teenagers regularly do), they know of no alternative but excessive, intense consumption patterns, leading them frequently to drink to intoxication. This chapter explores alternative models of drinking and channels for conveying them which emphasize healthy versus unhealthy consumption patterns as well as the individual's responsibility to manage his or her drinking. The ultimate goal is for people to see alcohol as an accompaniment to an overall healthy and pleasurable lifestyle, an image they enact as moderate, sensible drinking patterns.

Models of Alcohol's Effects

Selden Bacon, a founder and long-time director of the Yale (then Rutgers) Center of Alcohol Studies, remarked on the strange public health approach to alcohol taken in the United States and elsewhere in the Western world:

Current organized knowledge about alcohol use can be likened to... knowledge about automobiles and their use if the latter were limited to facts and theories about accidents and crashes.... [What is missing are] the positive functions and positive attitudes about alcohol uses in our as well as in other societies.... If educating youth about drinking starts from the assumed basis that such drinking is bad... full of risk for life and property, at best considered as an escape, clearly useless per se, and/or frequently the precursor of disease, and the subject matter is taught by nondrinkers and antidrinkers, this is a particular indoctrination. Further, if 75-80% of the surrounding peers and elders are or are going to become drinkers, there [is]... an inconsistency between the message and the reality. (Bacon, 1984, pp. 22-24)

When Bacon wrote these words, the coronary and mortality benefits of alcohol were only beginning to be established, while the psychological and social benefits of drinking had not been systematically assessed. His wry observations seem doubly relevant today, now that the life-prolonging effects of alcohol are on a firm footing (Doll, 1997; Klatsky, 1999) and the conference on which this volume is based has begun the discussion of the ways in which alcohol enhances quality of life (see also Baum-Baicker, 1985; Brodsky & Peele, 1999; Peele & Brodsky, 1998). In other words, if science indicates that alcohol conveys significant life advantages, why does alcohol policy act as though alcohol were evil?

Table 26.1 Views of alcohol in the United States.

Alcohol is bad

Alcohol is good

Alcohol is bad/good

An integrated approach

Model of alcohol use

Temperance/ proscriptive

Nontemperance/ permissive

Ambivalent/ prescriptive

Nontemperance/ prescriptive

Key ingredient

Abstinence; formal controls

Excessive drinking

Informally regulated drinking

Moderation; self-regulation

Consequence

Nonoptimal drinking/ health

Nonoptimal drinking/ health

Mixed or oscillating drinking

Healthy drinking

This chapter examines different views of alcohol as being either evil or good (Table 26.1). Two different typologies of social attitudes towards alcohol are employed. One is the distinction between temperance and nontemperance Western societies. In the former, major efforts have been mounted to ban alcoholic beverages (Levine, 1992). Less alcohol is consumed in temperance societies, with more outward signs of problematic use. In nontemperance societies, by contrast, alcohol is used almost universally, drinking is socially integrated, and few behavioral and other alcohol-related problems are noted (Peele, 1997).

An alternate typology has been used by sociologists to characterize norms and attitudes towards alcohol in subgroups within the larger society. Akers (1992) lists four such types of groups: (a) groups with proscriptive norms against the use of alcohol; (b) prescriptive groups that accept and welcome drinking but establish clear norms for its consumption; (c) groups with ambivalent norms that invite drinking but also fear and resent it; and (d) groups with permissive norms that not only tolerate and invite drinking but do not set limits on consumption or on behavior while drinking.

This chapter contrasts these different views of alcohol and the ways of approaching alcohol education and policy suggested by each. It additionally juxtaposes the potential consequences of each view and its educational approach.

Visions of Alcohol

Alcohol is Bad

The idea of alcohol as evil took root 150 to 200 years ago (Lender & Martin, 1987; Levine, 1978). Although this idea has varied in its intensity since then, antialcohol feeling has resurfaced and consumption has declined since the late 1970s in much of the Western world, led by the United States (Heath, 1989). The idea that alcohol is bad takes a number of forms. Of course, in the 19th and 20th centuries, the temperance movement held that alcohol is a negative force that must be eliminated from society because (in its view) of the following characteristics of alcohol:

Alcohol is an addictive substance whose use inevitably leads to increased, compulsive, and uncontrollable use.

Alcoholism as a Disease: The Inbred Alcoholic. The essential attributes of alcoholism as a disease were part of the temperance movement's view of alcohol. These were consolidated and reintegrated into the modern disease theory of alcoholism both through the development of Alcoholics Anonymous (AA), beginning in 1935, and in a modern medical approach, beginning in the 1970s and espoused currently by the directorship of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). AA popularized the idea that a small subgroup of individuals has a deeply ingrained form of alcoholism that prevents its members from drinking moderately. In the modern medical view, this has taken the form of the idea of a heavy genetic loading for alcoholism.

AA actually wished to coexist with alcohol in the post-prohibition era,1 because the signs were inescapable that the nation would no longer support national prohibition. If only certain individuals are stricken with alcoholism, then only they have to fear the evils that lurk in the beverage. For this limited group, however, the evils of alcohol are unlimited. They progressively lead the alcoholic (the drunkard or inebriate in temperance terms) to a total collapse of ordinary values and life structure and the ultimate depredations of death, the insane asylum, or prison.

A standard temperance view of alcohol was provided in the set of prints drawn by George Cruikshank, entitled The Bottle, included in Timothy Shay Arthur's 1848 Temperance Tales (see Lender & Martin, 1987). The Bottle comprised eight prints. After first sampling alcohol, the protagonist descends rapidly into a drunkard's hell. In short order he loses his job, the family is evicted and must beg on the streets, and so on. In the seventh print, the man kills his wife while he is drunk, leading to his commitment to an asylum in the last print. This sense of the imminent, horrible danger and death in alcohol is an integral part of the modern medical disease viewpoint as well. G. Douglas Talbott, president of the American Society of Addiction Medicine, wrote, "The ultimate consequences for a drinking alcoholic are these three: he or she will end up in jail, in a hospital, or in a graveyard" (Wholey, 1984, p. 19).

Alcohol Dependence and the Public Health Model. The modern medical viewpoint, despite its allegiance to genetic causality of alcoholism, is less committed than AA to the idea that alcoholism is in-born. For example, an NIAAA general population study (Grant & Dawson, 1998) assessed the risk of developing alcoholism to be much higher for youthful drinkers (a risk that was multiplied if alcoholism was present in the family). The model underlying this view of alcoholism's development is alcohol dependence, which holds that individuals drinking at a high rate for a substantial period develop a psychological and physiological reliance on alcohol (Peele, 1987). (It should be noted that the Grant and Dawson study (a) did not distinguish between those who first drank at home and those who drank with peers outside the home and (b) asked about first drinking "not counting small tastes or sips of alcohol" (p. 105), which more likely indicates first drinking other than within the family or at home.)

In addition to the disease and dependence views of alcohol's negative action, the modern public health view of alcohol is a drinking-problems model, which holds that only a minority of alcohol problems (violence, accidents, disease) are associated with alcoholic or dependent drinkers (see Stockwell & Single, 1999). Rather, it holds, drinking problems are spread across the population and can appear either because of acute intoxication even in occasional drinkers, cumulative effects from lower levels of nondependent drinking, or heavy drinking by a relatively small percentage of problem drinkers. In any case, according to the most popular public health viewpoint, alcohol problems are multiplied by higher levels of drinking society-wide (Edwards et al., 1994). The public health model sees not only alcohol dependence but all alcohol consumption as inherently problematic, in that greater consumption leads to greater social problems. The role of public health advocates in this view is to diminish alcohol consumption through whatever means possible.

Alcohol is Good

The view of alcohol as beneficent is ancient, as old at least as the idea that alcohol produces harm. The Old Testament describes alcoholic excess, but it also values alcohol. Both the Hebrew and Christian religions include wine in their sacramentsHebrew prayer bestows a blessing on wine. Even earlier, the Greeks considered wine a boon and worshipped a god of wine, Dionysius (the same god who stood for pleasure and revelry). From the ancients to the present, many have valued wine and other beverage alcohol for either their ritualistic benefits or their celebratory and even licentious aspects. The value of alcohol certainly was appreciated in colonial America, which drank freely and gladly, and where minister Increase Mather termed alcohol the "good creature of God" (Lender & Martin, 1987, p. 1).

Before Prohibition in the United States and from the 1940s through the 1960s, drinking alcohol was accepted and valued as was perhaps even excessive drinking. Musto (1996) has detailed cycles of attitudes towards alcohol in the United States, from the libertarian to the prohibitionistic. We can see the view of drinking and even alcohol intoxication as pleasurable in American film (Room, 1989), including also the work of such mainstream and morally upright artists as Walt Disney, who presented an entertaining and drunken Bacchus in his 1940 animated film, Fantasia. Television dramas in the 1960s casually depicted drinking by doctors, parents, and most adults. In the United States, one view of alcoholthe permissiveis associated with high consumption and few restraints on drinking (Akers, 1992; Orcutt, 1991).

Most drinkers throughout the Western world view alcohol as a positive experience. Respondents in surveys in the United States, Canada, and Sweden predominantly mention positive sensations and experiences in association with drinkingsuch as relaxation and sociabilitywith little mention of harm (Pernanen, 1991). Cahalan (1970) found that the most common result of drinking reported by current drinkers in the United States was that they "felt happy and cheerful" (50% of male and 47% of female nonproblem drinkers). Roizen (1983) reported national survey data in the United States in which 43% of adult male drinkers always or usually felt "friendly" (the most common effect) when they drank, compared with 8% who felt "aggressive" or 2% who felt "sad" (see Brodsky & Peele, 1999; Leigh, 1999).

Alcohol May Be Good or Bad

Of course, many of those sources for the goodness of alcohol also drew important distinctions among styles of alcohol use. Increase Mather's full view of alcohol was outlined in his 1673 tract Wo to Drunkards: "The wine is from God, but the Drunkard is from the Devil." Benjamin Rush, the colonial physician who first formulated a disease view of alcoholism, recommended abstinence only from spirits, and not wine or cider, as did the early temperance movement (Lender & Martin, 1987). It was only in the middle of the 19th century that teetotaling became the goal of temperance, a goal that was adopted by AA in the next century.

Some cultures and groups instead accept and encourage drinking, although they disapprove of drunkenness and antisocial behavior while drinking. Jews as an ethnic group typify this "prescriptive" approach to drinking, which allows frequent imbibing but strictly regulates the style of drinking and comportment when drinking, a style that leads overwhelmingly to moderate drinking with a minimal number of problems (Akers, 1992; Glassner, 1991). Modern epidemiologic research on alcohol (Camargo, 1999; Klatsky, 1999) embodies this view of alcohol's double-edged nature with the U- or J-shaped curve, in which mild to moderate drinkers display reduced coronary artery disease and mortality rates, but abstainers and heavier drinkers show depreciated health outcomes.

A less successful view of the "dual" nature of alcohol consumption is embodied by ambivalent groups (Akers, 1992), which both welcome alcohol's intoxicating effects and disapprove (or feel guilty about) excessive drinking and its consequences.

Alcohol and the Integrated Lifestyle

A view consistent with that in which alcohol may be used in either a positive or a negative fashion is one that sees healthful drinking not so much as the cause of either good and bad medical or psychosocial outcomes but as a part of an overall healthful approach to life. One version of this idea is embedded in the so-called Mediterranean diet, which emphasizes a balanced diet lower in animal protein than the typical American diet, and in which regular, moderate alcohol drinking is one central element. In line with this integrated approach, crosscultural epidemiologic research has shown that diet and alcohol contribute independently to coronary artery disease benefits in Mediterranean countries (Criqui & Ringle, 1994). Indeed, one can imagine other characteristics of Mediterranean cultures that lead to reduced levels of coronary artery diseasesuch as more walking, greater community supports, and less stressful lifestyles than in the United States and other temperance, generally Protestant, cultures.

Grossarth-Maticek (1995) has presented an even more radical version of this integrated approach, in which self-regulation is the fundamental individual value or outlook, and drinking moderately or healthily is secondary to this larger orientation:

"Troubled drinkers," i.e. people who both suffer from permanent stress and also impair their own self-regulation by drinking, only need a small daily dose to shorten their lives considerably. On the other hand, people who can regulate themselves well, and whose self-regulation is improved by alcohol consumption, even by a high dose, do not manifest a shorter life span or a higher frequency of chronic illnesses.

Drinking Messages and Their Consequences

Never Drink

The proscriptive approach to alcohol, characteristic for example of Moslem and Mormon societies, formally rules out all alcohol use. Within the United States, proscriptive groups include conservative Protestant sects and, often corresponding to such religious groupings, dry political regions. If those in such groups drink, they are at high risk for drinking excessively, because there are no norms to prescribe moderate consumption. This same phenomenon is seen in national drinking surveys, in which groups with high abstinence rates also display higher-than-average problem-drinking rates, at least among those who are exposed to alcohol (Cahalan & Room, 1974; Hilton, 1987, 1988).

Control Drinking

Temperance cultures (i.e., Scandinavian and English-speaking nations) foster the most active alcohol-control policies. Historically, these have taken the form of prohibition campaigns. In contemporary society, these nations enforce strict parameters for drinking, including regulation of the time and place of consumption, age restrictions for drinking, taxation policies, and so on. Nontemperance cultures show less concern in all these areas and yet report fewer behavioral drinking problems (Levine, 1992; Peele, 1997). For example, in Portugal, Spain, Belgium, and other countries, 16-year-olds (and those even younger) can drink alcohol freely in public establishments. These countries have almost no AA presence; Portugal, which had the highest per capita alcohol consumption in 1990, had 0.6 AA groups per million population compared with almost 800 AA groups per million population in Iceland, the country that consumed the least alcohol per capita in Europe. The idea of the need to control drinking externally or formally thus coincides with drinking problems in a paradoxically mutually reinforcing relationship.

At the same time, efforts to control or ameliorate drinking and drinking problems sometimes have untoward effects. In regard to treatment, Room (1988, p. 43) notes,

[We are in the midst] of a huge expansion in the treatment of alcohol-related problems in the United States [and industrialized nations worldwide]... In comparing Scotland and United States, on the one hand, with developing countries like Mexico and Zambia, on the other hand, in the World Health Organization Community Response Study, we were struck with how much more responsibility Mexicans and Zambians gave to family and friends in dealing with alcohol problems, and how ready Scots and Americans were to cede responsibility for these human problems to official agencies or to professionals. Studying the period since 1950 in seven industrialized nations.... [when] alcohol problem rates generally grew, we were struck by the concomitant growth of treatment provision in all of these countries. The provision of treatment, we felt, became a societal alibi for the dismantling of long-standing structures of control of drinking behavior, both formal and informal.

Room noted that, in the period from the 1950s through the 1970s, alcohol controls were relaxed and alcohol problems grew as consumption increased. This is the perceived relationship underlying the public policy approach of limiting consumption of alcohol. However, since the 1970s, alcohol controls in most countries (along with treatment) have increased and consumption has declined, but individual drinking problems have risen markedly (at least in the United States), particularly among men (Table 26.2). Around the point at which per capita consumption began to decline, between 1967 and 1984, NIAAA-funded national drinking surveys reported a doubling in self-reported alcohol-dependence symptoms without a concomitant increase in consumption among drinkers (Hilton & Clark, 1991).

Table 26.2 Dependence-drinking problems among U.S. drinkers.

Respondents reporting at least one dependence symptom over prior year (%)

Drink for Enjoyment

Most people drink in line with the standards of their social environments. The definition of enjoyable drinking varies according to the group of which the drinker is a part. Clearly, some societies have a different sense of the enjoyment of alcohol relative to its dangers. One definition of nontemperance cultures is that they conceive of alcohol as a positive pleasure, or as a substance whose use is valued in itself. Bales (1946), Jellinek (1960), and others have distinguished the very different conceptions of alcohol that characterize temperance and nontemperance cultures such as, respectively, the Irish and the Italian: In the former, alcohol connotes imminent doom and danger and at the same time freedom and license; in the latter alcohol is not conceived as creating social or personal problems. In Irish culture, alcohol is separated from the family and is used sporadically in special circumstances. In the Italian, drinking is conceived as a commonplace, but joyous, social opportunity.

Societies characterized by the permissive social style of drinking also might be seen to conceive of drinking in a predominantly enjoyable light. However, in this environment, excessive drinking, intoxication, and acting out are tolerated and are in fact seen as a part of the enjoyment of alcohol. This is different from the prescriptive society, which values and appreciates drinking but which limits the amount and style of consumption. The latter is consistent with nontemperance cultures (Heath, 1999). Just as some individuals shift from high consumption to abstinence and some groups have both high abstinence and high excessive-drinking rates, permissive cultures can become aware of the dangers of alcohol and shift as a society into ones that impose strict alcohol controls (Musto, 1996; Room, 1989).

Drink for Health

The idea that alcohol is healthy is also ancient. Drinking throughout the ages has been thought to enhance appetite and digestion, assist in lactation, reduce pain, create relaxation and bring rest, and actually attack some diseases. Even in temperance societies, people may regard a drink of alcohol as healthful. The health benefits of moderate alcohol consumption (as opposed to both abstinence and heavy drinking) were first presented in a modern medical light in 1926 by Raymond Pearl (Klatsky, 1999). Since the 1980s, and with greater certainty in the 1990s, prospective epidemiologic studies have found that moderate drinkers have a lower incidence of heart disease and live longer than abstainers (see Camargo, 1999; Klatsky, 1999).

The United States typifies a modern society with a highly developed and educated consumer class characterized by an intense health consciousness. Bromides, vitamins, and foods are sold and consumed widely on the basis of their supposed healthfulness. There are few cases, if any, in which the healthfulness of such folk prescriptions is as well established as in the case of alcohol. Indeed, the range and solidity of the findings of medical benefits of alcohol rival and exceed the empirical basis for such claims for many pharmaceutical substances. Thus, a basis has been built for drinking as a part of a regulated health program.

Yet, residual attitudes in the United Statesa temperance societyconflict with a recognition and utilization of alcohol's health benefits (Peele, 1993). This environment creates conflicting pressures: Health consciousness presses towards consideration of the healthfulness and life-prolonging effects of drinking, but traditional and medical antialcohol views work against presenting positive messages about drinking. Bradley, Donovan, and Larson (1993) describe this failure of medical professionals, out of either fear or ignorance, to incorporate recommendations for optimal drinking levels in interactions with patients. This omission both denies information about life-saving benefits of alcohol to patients who might benefit and fails to take advantage of a large body of research that shows that "brief interventions," in which health professionals recommend reduced drinking, are highly cost-effective tools for combating alcohol abuse (Miller et al., 1995).

Who Gives Drinking Messages and What Do They Say?

Government or Public Health

The view of alcohol presented by government, at least in the United States, is almost entirely negative. Public announcements about alcohol are always of its dangers, never of its benefits. The public health position on alcohol in North America and Europe (WHO, 1993) is likewise strictly negative. Government and public health bodies have decided that it is too risky to inform people at large of the relative risks, including the benefits, of drinking because this may lead them to greater excesses of drinking or serve as an excuse for those already drinking excessively. Although Luik (1999) views the government's discouragement of pleasurable activities (such as drinking), which he accepts as being unhealthy, as paternalistic and unnecessary, in fact, in the case of alcohol, such discouragement is counterproductive even as far as health goes. As Grossarth-Maticek and his colleagues have shown (Grossarth-Maticek & Eysenck, 1995; Grossarth-Maticek, Eysenck, & Boyle, 1995), self-regulating consumers who feel they can control their own outcomes are healthiest.

Industry Advertising

Nongovernmentally supported, non-public health advertising, that is, commercial advertising by alcohol manufacturers, frequently advises drinkers to drink responsibly. The message is reasonable enough but falls far short of encouraging a positive outlook towards alcohol as part of an overall healthful lifestyle. The industry's reticence in this area is caused by a combination of several factors. Much of the industry fears making health claims for its products, both because of the potential for incurring governmental wrath and also because such claims could expose them to legal liability. Thus, industry advertising does not suggest positive drinking images so much as it seeks to avoid responsibility for suggesting or supporting negative drinking styles.

Schools

The absence of a balanced view of alcohol is as noteworthy in educational settings as in public health messages. Elementary and secondary schools simply fear the disapprobation and liability risks of anything that might be taken to encourage drinking, particularly because their charges are not yet of the legal drinking age in the United States (compare this with private schools in France, which serve their students wine with meals). What may be even more puzzling is the absence of positive drinking messages and opportunities on American college campuses, where drinking is nonetheless widespread. Without a positive model of collegiate drinking to offer, nothing appears to counterbalance the concentrated and sometimes compulsive nature (termed "bingeing," see Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994) of this youthful imbibing.

Family, Adults, or Peers

Because contemporaneous social groups provide the greatest pressures and supports for drinking behavior, families, other present adults, and peers are the most critical determinants of styles of drinking (Cahalan & Room, 1974). These different social groups tend to affect individuals, particularly young individuals, differently (Zhang, Welte, & Wieczorek, 1997). Peer drinking, among the young in particular, connotes illicit and excessive consumption. Indeed, one reason to allow young people to drink legally is that they then are more likely to drink with adultsrelated or otherwisewho as a rule tend to drink more moderately. Most bars, restaurants, and other social drinking establishments encourage moderate drinking, and thus such establishments and their patrons can serve as socializing forces for moderation.

Of course, social, ethnic, and other background factors influence whether positive modeling of drinking will occur in these groups. For example, young people with parents who abuse alcohol would do best to learn to drink outside the family. And this is the central problem with instances in which the family provides the primary model for drinking behavior. If the family is unable to set an example for moderate drinking, then individuals whose families either abstain or drink excessively are left without adequate models after which to fashion their own drinking patterns. This is not an automatic disqualification for becoming a moderate drinker, however; most offspring of either abstinent or heavy-drinking parents gravitate towards community norms of social drinking (Harburg, DiFranceisco, Webster, Gleiberman, & Schork, 1990).

Not only do parents sometimes lack social-drinking skills, those who possess them are often under attack from other social institutions in the United States. For example, totally negative alcohol education programs in schools liken alcohol to illicit drugs, so that children are confounded to see their parents openly practicing what they are told is a dangerous or negative behavior.

What Should Young People Learn About Alcohol and Positive Drinking Habits?

Thus, there are substantial deficiencies in the available options for teaching, modeling, and socializing positive drinking habits-exactly the ones Bacon identified 15 years ago. Current models leave a substantial gap in what children and others learn about alcohol, as shown by the 1997 Monitoring the Future data (Survey Research Centers, 1998a, 1998b) for highschool seniors (see Table 26.3).

These data indicate that, although three quarters of high school seniors in the U.S. have drunk alcohol over the year, and more than half have been drunk, 7 in 10 disapprove of adults drinking regular, moderate amounts of alcohol (more than disapprove of heavy weekend drinking). In other words, what American students learn about alcohol leads them to disapprove of a healthful style of drinking, but at the same time they themselves drink in an unhealthy fashion.

Conclusion

In place of messages that lead to a dysfunctional combination of behavior and attitudes, a model of sensible drinking should be presenteddrinking regularly but moderately, drinking integrated with other healthy practices, and drinking motivated, accompanied by, and leading to further positive feelings. Harburg, Gleiberman, DiFranceisco, and Peele (1994) have presented such a model, which they call "sensible drinking." In this view, the following set of prescriptive and pleasurable practices and recommendations should be communicated to young people and others:

Alcohol is a legal beverage widely available in most societies throughout the world.

Alcohol may be misused with serious negative consequences.

Alcohol is more often used in a mild and socially positive fashion.

Alcohol used in this fashion conveys significant benefits, including health, quality-of- life, and psychological and social benefits.

It is critical for the individual to develop skills to manage alcohol consumption.

Some groups use alcohol almost exclusively in a positive fashion, and this style of drinking should be valued and emulated.

Positive drinking involves regular moderate consumption, often including other people of both genders and all ages and usually entailing activities in addition to alcohol consumption, where the overall environment is pleasanteither relaxing or socially stimulating.

Alcohol, like other healthful activities, both takes its form and produces the most benefit within an overall positive life structure and social environment, including group supports, other healthful habits, and a purposeful and engaged lifestyle.

If we fear communicating such messages, then we both lose an opportunity for a significantly beneficial life involvement and actually increase the danger of problematic drinking.

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